16 Moving, Handling, and Positioning the Surgical Patient
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 16.1: Safely Transporting and Transferring Patients
- 1. List and discuss the principles of safe patient transport and transfer
- 2. Demonstrate professional communication skills with families of patients being transported to surgery
- 3. Use safe body mechanics during patient transportation, transferring, and positioning
- 4. Discuss common methods of patient transport and lateral moving devices used in the perioperative environment
Lesson 16.2: Patient Positioning and Safety in the Operating Room
- 5. Describe guidelines for transporting special patient populations
- 6. Describe the responsibilities of the surgical technologist in patient positioning
- 7. Demonstrate the use of common operating table accessories and positioning devices
- 8. Describe how to prevent patient injury during positioning
- 9. Discuss the principles of safe positioning
- 10. Demonstrate basic positions used in surgical procedures
- 11. Discuss the safety precautions for each position
1.
Classroom Preparation
Lesson 16.1: Safely Transporting and Transferring Patients
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 1. List and discuss the principles of safe patient transport and transfer
- 2. Demonstrate professional communication skills with families of patients being transported to surgery
- 3. Use safe body mechanics during patient transportation, transferring, and positioning
- 4. Discuss common methods of patient transport and lateral moving devices used in the perioperative environment
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 16.1: Safely Transporting and Transferring Patients
STUDENT PREPARATION (1 hr)
| 1 | READ – Chapter Heading(s) • Introduction • Section I: Transport and Transfers • Patient Identification Examples for Verbal Patient Identification ANSWER – Textbook • Review Question 3 • Case Study 1 ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 2 | READ – Chapter Heading(s) • Safety First Communication and Teamwork Count ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 3 | READ – Chapter Heading(s) • Safety First ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 4 | READ – Chapter Heading(s) • Transport by Gurney • Bed to Gurney: Bringing a Patient to the Operating Room • Performing Assisted Lateral Transfers Performing the Log Roll and Assisted Lateral Transfer • Wheelchair Transfer and Transport Safety Guidelines for Wheelchair Transport Assisting a Patient from Bed to Wheelchair Sitting to Standing Position Standing Position to Wheelchair Wheelchair to Bed • Assisting an Ambulatory Patient Assisting a Falling Patient ANSWER – Textbook • Review Question 2 • Case Study 2 ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 16.1: Safely Transporting and Transferring Patients
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 1 | PRINCIPLES OF SAFE TRANSPORT AND TRANSFER: SLIDES 4-5 | • Introduction • Section I: Transport and Transfers • Patient Identification Examples for Verbal Patient Identification |
| 2 | COMMUNICATION: SLIDES 6-7 | • Safety First Communication and Teamwork Count |
| 3 | BODY MECHANICS: SLIDES 8-9 | • Safety First |
| 4 | COMMON TRANSPORT AND TRANSFER METHODS: SLIDES 10-11 | • Transport by Gurney • Bed to Gurney: Bringing a Patient to the Operating Room • Performing Assisted Lateral Transfers Performing the Log Roll and Assisted Lateral Transfer • Wheelchair Transfer and Transport Safety Guidelines for Wheelchair Transport Assisting a Patient from Bed to Wheelchair Sitting to Standing Position Standing Position to Wheelchair Wheelchair to Bed • Assisting an Ambulatory Patient Assisting a Falling Patient |
Learning Activities (choose one or more to equal 50 min)
| 1 | ROLE PLAY (50 min) • Demonstrate the principles of safe patient transport and transfer and then have the students role play each operating room team member (rotating roles) and have them practice transporting and transferring. Appropriate Settings: Traditional classroom |
| 2 | ROLE PLAY (50 min) • Demonstrate to the students the proper communication with the family when transporting patients. Have students role play transporting a patient to the operating room and communicating with the family, where to go, what elevator to take, procedure when the family gets to the preoperative area, location of the cafeteria, and where to wait after surgery begins. • Appropriate Settings: Traditional classroom |
| 3 | DEMONSTRATE (50 min) • Demonstrate the use of proper body mechanics during patient transport, transferring, and positioning. Students can practice transferring, transporting, and positioning. Appropriate Settings: Traditional classroom INVITE (50 min) • Invite a nurse as a guest speaker to demonstrate proper postures for lifting, pushing, pulling, and reaching. To prevent injury, these postures (especially any “improper” postures being highlighted) should be demonstrated with little or no actual load. Appropriate Settings: Traditional/online/flipped classroom |
| 4 | DEMONSTRATE (50 min) • Call on one or more volunteers and demonstrate together how to transfer a person from a stretcher to an operating table, and from an operating table back to a stretcher. Then, under supervision of guest speaker and instructor, groups of students take turns transferring a classmate “patient” from a stretcher to an operating table, and back from the table to a stretcher. • Demonstrate how to move a stretcher carrying a “patient” down a hallway near the classroom. Then, under supervision of guest speaker and instructor, students take turns moving the stretcher down the hall. Have them practice first moving the stretcher alone, then as part of a two-person team. • Demonstrate the different scenarios involving transferring and transporting ambulatory and wheelchair-assisted patients. Borrow a wheelchair from another department and have the students practice transferring patients under different circumstances. • Demonstrate how to assist a falling patient. Follow up with a discussion of the procedure for documenting the fall of a patient. Appropriate Settings: Traditional classroom |
Critical Thinking Question
You are about to transport an elderly patient, Jason Smith, whom you know has some memory problems. During the patient identification step, Mr. Smith identifies himself and tells you he will be having surgery on his right arm. However, Mr. Smith’s chart says that the surgery will be on his left arm. You’re sure that there will be some waiting time between transport and surgical prep, and you don’t want to cause any unnecessary delay, so you plan to transport the patient and then check on the situation. Is this an acceptable plan? Why or why not?
Discussion Guidelines: Students might discuss why it is inappropriate to transfer Mr. Smith until the surgical site information has been verified. Even if the surgical technologist intends to check on the situation immediately after transport, he or she is relying on being able to complete this task before the surgical preparation begins. The surgical technologist might be distracted by another matter and be unable (or forget) to finish checking on the situation. It is also dangerous to assume that Mr. Smith is merely forgetful or doesn’t understand the surgery; this is not the surgical technologist’s judgment to make. The correct procedure is for the surgical technologist to report the discrepancy to the unit charge nurse and then call the operating room to inform them of the delay.
Classroom Preparation
Lesson 16.2: Patient Positioning and Safety in the Operating Room
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 5. Describe guidelines for transporting special patient populations
- 6. Describe the responsibilities of the surgical technologist in patient positioning
- 7. Demonstrate the use of common operating table accessories and positioning devices
- 8. Describe how to prevent patient injury during positioning
- 9. Discuss the principles of safe positioning
- 10. Demonstrate basic positions used in surgical procedures
- 11. Discuss the safety precautions for each position
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 16.2: Patient Positioning and Safety in the Operating Room
STUDENT PREPARATION (1 hr)
| 5 | READ – Chapter Heading(s) • Special Patient Populations Pediatric Patients Hearing- or Sight-Impaired Patients Bariatric Patients Patients in Police Custody ANSWER – Textbook • Review Question 5 ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 6 | READ – Chapter Heading(s) • Principles of Safe Positioning • Role of the Surgical Technologist in Positioning ANSWER – Textbook • Case Study 5 ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 7 | READ – Chapter Heading(s) • General Operating Table Positioning Aids ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 8 | READ – Chapter Heading(s) • Potential Patient Injuries Decubitus Ulcer Shearing Injury Musculoskeletal and Compression Injury Eye and Ear Injury Physiological Alteration Thrombosis and Embolism ANSWER – Textbook • Review Questions 1, 6 • Case Studies 3, 4 ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 9 | READ – Chapter Heading(s) • Patient Safety During Positioning Normal Range of Motion ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 10 | READ – Chapter Heading(s) • Surgical Positions • Supine (Dorsal Recumbent) • Trendelenburg • Reverse Trendelenburg • Lithotomy • Fowler and Modified Fowler • Lateral Decubitus • Prone • Jackknife (Kraske) Position • Spinal Table • Orthopedic Table ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 11 | READ – Chapter Heading(s) • Surgical Positions • Supine (Dorsal Recumbent) • Trendelenburg • Reverse Trendelenburg • Lithotomy • Fowler and Modified Fowler • Lateral Decubitus • Prone • Jackknife (Kraske) Position • Spinal Table • Orthopedic Table ANSWER – Textbook • Review Questions 4, 7 ANSWER – Workbook • Chapter 16 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 16.2: Patient Positioning and Safety in the Operating Room
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 5 | SPECIAL PATIENT POPULATIONS: SLIDE 13 | • Special Patient Populations Pediatric Patients Hearing- or Sight-Impaired Patients Bariatric Patients Patients in Police Custody |
| 6 | ST RESPONSIBILITIES: SLIDES 14-15 | • Principles of Safe Positioning • Role of the Surgical Technologist in Positioning |
| 7 | OPERATING TABLE AND ACCESSORIES: SLIDES 16-18 | • General Operating Table Positioning Aids |
| 8 | INJURY PREVENTION: SLIDE 19 | • Potential Patient Injuries Decubitus Ulcer Shearing Injury Musculoskeletal and Compression Injury Eye and Ear Injury Physiological Alteration Thrombosis and Embolism |
| 9 | SAFE POSITIONING: SLIDE 20 | • Patient Safety During Positioning Normal Range of Motion |
| 10 | BASIC POSITIONS: SLIDE 21 | • Surgical Positions • Supine (Dorsal Recumbent) • Trendelenburg • Reverse Trendelenburg • Lithotomy • Fowler and Modified Fowler • Lateral Decubitus • Prone • Jackknife (Kraske) Position • Spinal Table • Orthopedic Table |
| 11 | SAFETY PRECAUTIONS: SLIDE 21 | • Surgical Positions • Supine (Dorsal Recumbent) • Trendelenburg • Reverse Trendelenburg • Lithotomy • Fowler and Modified Fowler • Lateral Decubitus • Prone • Jackknife (Kraske) Position • Spinal Table • Orthopedic Table |
Learning Activities (choose one or more to equal 50 min)
| 5 | INVITE (30 min) • Invite an instructor to demonstrate how to use the cover on a crib designed for transporting an infant or small child. If the guest or instructor has experience transporting children, have him or her discuss what techniques or approaches have been most helpful. If time permits, have students practice covering a crib and transporting an infant or child. Appropriate Settings: Traditional classroom |
| 6 | DISCUSS (30 min) • Break the class into four groups. Assign each group two or three of the “principles of safe patient transport.” Have each group discuss its assigned principles and think of at least one example of putting each assigned principle into practice. After discussion, have each group share its assigned principles and practice examples with the rest of the class. In their discussion, emphasis should be placed on OSHA safety techniques and the proper use of a safety strap on the patient. • Appropriate Settings: Traditional/online/flipped classroom |
| 7 | DEMONSTRATE (50 min) • Demonstrate common operating table accessories. Demonstrate the proper way the accessory is attached to the table. Have the students demonstrate how to attach the accessory to the table. Appropriate Settings: Traditional classroom INVITE (50 min) • Invite an instructor to demonstrate to the students the proper use of the operating table controls and adjustments. If more than one brand of table is available, briefly point out the similarities and differences. If time permits, have students practice using the operating table controls and adjustments. • Appropriate Settings: Traditional classroom |
| 8 | PRACTICE (50 min) • Two student volunteers come to the front of the class; one is the “model,” the other is the “teacher.” The “teacher,” with the help of the instructor, uses a piece of colored yarn to demonstrate the location of the following nerves on the “model.” The “teacher” and instructor also demonstrate on the “model” some of the key locations where pressure can cause injury to these nerves. • Appropriate Settings: Traditional classroom |
| 9 | DEMONSTRATE (30 min) • Demonstrate to the class the principles of safe positioning. Use positioning devices. Demonstrate the improper way to position and see if the students can point out the safety hazards. • Appropriate Settings: Traditional classroom |
| 10 | PRACTICE (50 min) • Under supervision of the instructor, students take turns positioning their classmates on the operating table in the positions described in this chapter, including appropriate placement of padding. The “patient” should try to remain limp and not assist the other students with the positioning. After positioning, have the “patient” note and report where he or she feels pressure or discomfort from the position. • Appropriate Settings: Traditional classroom |
| 11 | PRACTICE (50 min) • Under supervision of the instructor, students will take turns turning their classmates from the supine to the prone position, including appropriate placement of padding. The “patient” should try to remain limp and not assist the other students with the positioning. After positioning, have the “patient” note and report to the other students where he or she feels pressure or discomfort from the position. • Appropriate Settings: Traditional classroom |
Critical Thinking Question
There are many principles and guidelines given in the textbook for how to safely position a patient, but no single set of directions on exactly how to put a patient into a particular surgical position. Aunt Emma wonders why if all of this is so important, you don’t just have a “cookbook” of procedures that can be followed in every case. What will you tell your Aunt Emma about why there isn’t a single set of rules for positioning?
Discussion Guidelines: Students might discuss the factors that go into safe positioning of a surgical patient. Every patient has individual characteristics of size, weight, and gender, as well as a unique health history. Some patients will have limited range of motion, some will be pregnant, some will be prone to blood pressure changes, some will have had previous surgeries, and so on. Even the type of table and equipment in a given operating room might influence how the patient will be handled and positioned. Students should learn all they can about the normal body range of motion, areas that are sensitive to pressure, and other factors, and use this knowledge when working with a team to position a patient for surgery.
A member of the surgical team has accidentally ripped his glove and needs to change it. You and two other team members are available to turn the patient, and everything else is ready for the surgery to proceed. Can the three of you take care of turning the patient while your colleague changes his glove? Why or why not?
Discussion Guidelines: The students can discuss why the turning must not proceed until there are enough people (four to six) to do it correctly and according to whatever procedure the surgical team normally follows. The three people present can probably get the patient turned onto her stomach, but there must also be enough people to ensure that her spine and head are kept in alignment and to properly position the chest rests or other bracing. The few minutes that might be “saved” are not worth the risk to the patient’s safety, not to mention the risk of injury to surgical team members.
Assessments
Chapter 16: Moving, Handling, and Positioning the Surgical Patient
ASSESSMENTS BY OBJECTIVE
| 1-11 | Workbook • Chapter 16 Evolve Instructor Resources • Test Bank Create a quiz using ExamView; sort by objective. Evolve Student Resources • Mock Certification Exam • Review Questions |
| All | Elsevier Adaptive Quizzing • Chapter 16 – Graded quizzes (Mastery Levels 1, 2, and 3) |
